How to identify gastric and duodenal ulcers. How to identify the first signs of a stomach and duodenal ulcer? How to suspect the presence of a duodenal ulcer
![How to identify gastric and duodenal ulcers. How to identify the first signs of a stomach and duodenal ulcer? How to suspect the presence of a duodenal ulcer](https://i0.wp.com/krasotaimedicina.ru/upload/iblock/520/5200fafab62fb74691de8e252981f838.jpeg)
Peptic ulcer of the duodenum- a disease of the duodenum of a chronic relapsing nature, accompanied by the formation of a defect in its mucous membrane and the tissues located underneath it. It manifests itself as severe pain in the left epigastric region, occurring 3-4 hours after eating, attacks of “hungry” and “night” pain, heartburn, acid belching, and often vomiting. The most serious complications are bleeding, perforation of the ulcer and its malignant degeneration.
General information
Duodenal ulcer is a chronic disease characterized by the occurrence of ulcerative defects in the duodenal mucosa. It lasts a long time, alternating periods of remission with exacerbations. Unlike erosive damage to the mucosa, ulcers are deeper defects that penetrate into the submucosal layer of the intestinal wall. Duodenal ulcer occurs in 5-15 percent of citizens (statistics vary depending on the region of residence), and is more common in men. Duodenal ulcers are 4 times more common than gastric ulcers.
Reasons for development
The modern theory of the development of peptic ulcer considers the key factor in its occurrence to be infection of the stomach and duodenum by the bacteria Helicobacter Pylori. This bacterial culture is sown during bacteriological examination of gastric contents in 95% of patients with duodenal ulcers and in 87% of patients suffering from gastric ulcers.
However, infection with Helicobacter does not always lead to the development of the disease; in most cases, asymptomatic carriage occurs.
Factors contributing to the development of duodenal ulcer:
- nutritional disorders - improper, irregular nutrition;
- frequent stress;
- increased secretion of gastric juice and decreased activity of gastroprotective factors (gastric mucoproteins and bicarbonates);
- smoking, especially on an empty stomach;
- long-term use of medications that have an ulcerogenic (ulcer-generating) effect (most often these are drugs from the group of non-steroidal anti-inflammatory drugs - analgin, aspirin, diclofenac, etc.);
- gastrin-producing tumor (gastrinoma).
Duodenal ulcers that occur as a result of taking medications or accompanying gastrinoma are symptomatic and are not included in the concept of peptic ulcer disease.
Classification of peptic ulcer
Peptic ulcer disease varies by location:
- Peptic ulcer of the stomach (cardia, subcardial region, body of the stomach);
- peptic post-resection ulcer of the pyloric canal (anterior, posterior wall, lesser or greater curvature);
- duodenal ulcer (bulbous and postbulbar);
- ulcer of unspecified localization.
According to the clinical form, acute (newly diagnosed) and chronic peptic ulcer disease are distinguished. The phase is divided into periods of remission, exacerbation (relapse) and incomplete remission or fading exacerbation. Peptic ulcer disease can occur latently (without pronounced clinical symptoms), mildly (with rare relapses), moderately severe (1-2 exacerbations per year) and severely (with regular exacerbations up to 3 or more times a year).
The duodenal ulcer itself varies in morphological picture: acute or chronic ulcer, small (up to half a centimeter), medium (up to a centimeter), large (from one to three centimeters) and gigantic (more than three centimeters) in size. Stages of ulcer development: active, scarring, “red” scar and “white” scar. With concomitant functional disorders of the gastroduodenal system, their nature is also noted: violations of motor, evacuation or secretory function.
Symptoms of duodenal ulcer
In children and the elderly, the course of peptic ulcer disease is sometimes practically asymptomatic or with minor manifestations. This course is fraught with the development of severe complications, such as perforation of the duodenal wall followed by peritonitis, hidden bleeding and anemia. The typical clinical picture of duodenal ulcer is a characteristic pain syndrome.
The pain is most often moderate and dull. The severity of pain depends on the severity of the disease. Localization is usually in the epigastrium, under the sternum. Sometimes the pain can be diffuse in the upper abdomen. It often occurs at night (at 1-2 hours) and after long periods without eating, when the stomach is empty. After eating, milk, and antacids, relief occurs. But most often the pain returns after the stomach contents are evacuated.
The pain can occur several times a day for several days (weeks), after which it goes away on its own. However, over time, without proper therapy, relapses become more frequent and the intensity of the pain increases. Seasonality of relapses is characteristic: exacerbations occur more often in spring and autumn.
Complications of duodenal ulcer
The main complications of a duodenal ulcer are penetration, perforation, bleeding and narrowing of the intestinal lumen. Ulcerative bleeding occurs when the pathological process affects the vessels of the gastric wall. Bleeding can be hidden and manifested only by increasing anemia, or it can be pronounced, blood can be found in vomit and appear during bowel movements (black or bloody stool). In some cases, bleeding can be stopped during an endoscopic examination, when the source of bleeding can sometimes be cauterized. If the ulcer is deep and the bleeding is profuse, surgical treatment is prescribed; in other cases, it is treated conservatively, correcting iron deficiency. For ulcer bleeding, patients are prescribed strict fasting and parenteral nutrition.
Perforation of a duodenal ulcer (usually the anterior wall) leads to penetration of its contents into the abdominal cavity and inflammation of the peritoneum - peritonitis. When the intestinal wall is perforated, a sharp cutting-stabbing pain in the epigastrium usually occurs, which quickly becomes diffuse and intensifies with a change in body position and deep breathing. Symptoms of peritoneal irritation (Shchetkin-Blumberg) are determined - when pressing on the abdominal wall and then suddenly releasing it, the pain intensifies. Peritonitis is accompanied by hyperthermia.
This is an emergency condition that, without proper medical care, leads to shock and death. Perforation of an ulcer is an indication for urgent surgical intervention.
Prevention and prognosis of duodenal ulcer
Measures to prevent the development of duodenal ulcer:
- timely detection and treatment of Helicobacter pylori infection;
- normalization of diet and nutrition;
- quitting smoking and alcohol abuse;
- control over medications taken;
- harmonious psychological environment, avoidance of stressful situations.
Uncomplicated peptic ulcer disease, with proper treatment and compliance with dietary and lifestyle recommendations, has a favorable prognosis; with high-quality eradication, ulcer healing and cure. The development of complications during peptic ulcer disease worsens the course and can lead to life-threatening conditions.
Severe pain in the upper abdomen can be a manifestation of serious intestinal pathologies, which are extremely difficult to get rid of without medical help. Moreover, the symptoms and treatment of duodenal ulcers are always interconnected, since not only the speed of elimination of signs of pathology, but also the possibility of complete healing depends on the degree of adequacy of therapy.
Peptic ulcer disease is characterized by the formation of deep erosive foci on the surface of the mucous membrane covering the intestinal wall. The type of pathology is determined by the location of the affected areas. A disease in which ulcerative formations occur in the initial part of the small intestine is diagnosed as a duodenal ulcer.
The main reason for the development of ulcers is damage to intestinal tissue.
Factors that provoke such lesions include:
- Helicobacter Pylori is a spiral-shaped bacterium, the only microorganism that can live in an acidic environment. The infection penetrates the mucous membrane and contributes to the development of erosions and ulcers on the walls of the stomach and intestines;
- increased acid levels of gastric juice. Regular exposure of the intestinal walls to hydrochloric acid causes a violation of their integrity;
- alcohol and smoking are powerful irritants of the mucous membrane of all parts of the gastrointestinal tract, including the duodenum;
- poor nutrition affects the production of intestinal mucous substances and disrupts its motility, which ultimately affects the condition of the lining of its walls;
- Anti-inflammatory drugs can affect the epithelial surface if taken regularly.
In some cases, duodenal ulcer can occur under the influence of other pathologies - cirrhosis, lymphoma, renal failure, COPD.
In addition, the state of the immune system is of great importance in the development of pathological processes - even a slight decrease in its potential can lead to inflammation and erosions that transform into ulcers.
Early signs and symptoms
The course of the disease is characterized by periodic exacerbations and periods of remission. At an early stage of development, peptic ulcer disease is characterized by the appearance of pain in the stomach, more often at night. Pain syndromes vary in intensity and can radiate to the heart or back.
Often attacks of pain occur in a state of hunger and disappear after eating. In older people, ulcers may develop without significant symptoms.
In addition to pain, characteristic signs of intestinal ulceration include:
- nausea;
- heartburn;
- diarrhea or constipation;
- belching sour;
- attacks of hunger;
- bloating and flatulence;
- in the later stages - vomiting with blood and feces with blood in it.
Exacerbations of duodenal ulcers are seasonal and are observed in the spring and autumn.
A characteristic feature of ulcerative formations is partial loss of tissue. Even after complete recovery, the affected tissues are not restored, and scars form at the site of damage.
Possible complications of peptic ulcer disease
Pathological processes associated with the development of ulcers in the small intestine, if untreated, tend to progress and are not capable of self-healing. Defects caused by ulcerative formations worsen with each exacerbation of the disease, and emerging complications can become a real threat to the patient’s life.
The most dangerous complications of peptic ulcer disease are bleeding, perforation, penetration and malignancy.
Bleeding from the duodenum
Ulcerative bleeding is one of the main causes of death when the gastrointestinal tract is affected.
The main signs of bleeding are vomiting blood and dark or black stools. The pathological process is accompanied by the appearance of weakness and chills, dizziness and rapid heartbeat, dry mouth and attacks of nausea.
If the main symptoms of bleeding appear, you should urgently call an ambulance. Before the doctors arrive, make sure to apply a cold compress to the abdomen.
Such pathological processes are possible only in the case of an extremely advanced state of the patient. The severity and consequences of bleeding may vary.
In some cases, spontaneous cessation of bleeding is possible. But deaths that occur within a few minutes after the onset of an exacerbation are also common.
Perforation of the ulcer
The progressive development of ulcerative lesions contributes to the gradual thinning of the intestinal wall and the formation of a through wound in it - a hole through which part of the undigested contents of the small intestine leaks out into the abdominal cavity.
The patient’s condition at this moment deteriorates sharply:
- there is a sharp acute pain in the abdomen, due to which the person is unable to move;
- possible loss of consciousness;
- intense increase in body temperature;
- dry mouth and feeling of thirst increases;
- cold sweat;
- pale skin;
- fingers become cold;
- the sensitivity of the skin of the abdomen to touch increases;
- blood pressure drops quickly.
Perforation of an ulcer is one of the most dangerous complications in terms of consequences. Only timely medical care can stop the pathogenic process and prevent its consequences.
In the absence of treatment, against the background of the spread of intestinal contents in the abdominal cavity, intensive development of bacteria occurs. Most often, the result of a complication is peritonitis, in which a person dies within 4 hours.
Malignancy
Malignancy is a process that activates the degeneration of ulcerative cells into malignant ones. Cancerous changes are characterized by irregular pain, the occurrence of which is not associated with external factors or visible causes.
With malignancy, the patient's condition changes gradually - signs of gastrointestinal dysfunction, nausea and vomiting appear, then anemia develops, a change in the sense of smell and an aversion to meat products.
Diagnosis and treatment of duodenal ulcer
To accurately confirm the diagnosis of ulcerative lesions of the initial part of the small intestine, the results of laboratory and instrumental studies are necessary:
- clinical blood test;
- stool analysis;
- radiography;
- endoscopy is the most informative diagnostic method;
- biopsy - examination under a microscope of a tissue sample taken from the affected area of the intestine;
- serological tests, testing for Helicobacter Pylori;
- determination of the level of acid-forming function through daily pH monitoring.
Experienced gastroenterologists can determine the presence of an ulcer by palpating the abdomen.
Drug treatment
In case of exacerbation of the disease, treatment takes place in a hospital, while chronic forms of the disease can be treated at home. Under inpatient observation conditions, the patient was prescribed rest and bed rest.
The main strategy according to which drug treatment of duodenal ulcers is carried out is developed based on the results of studies.
The following groups of drugs are considered the most effective means of drug therapy:
- antisecretory. It consists of drugs that inhibit gastric secretion, and therefore the aggressive effects of hydrochloric acid;
- containing bismuth. This type of medicine prevents the development of pathogenic bacteria, forming a protective film on the surface of the mucosa;
- antibacterial and antiprotozoal. Include drugs that inhibit the vital activity of Helicobacter pylori;
- prokinetics - drugs that normalize intestinal motility and prevent nausea and vomiting;
- antacids. Drugs that eliminate heartburn and its characteristic symptoms, as well as the feeling of discomfort associated with the heaviness and fullness of the stomach;
- gastroprotective drugs - have the ability to protect the mucous membrane and prevent damage from hydrochloric acid and gastric juice enzymes;
- additional means to eliminate the symptoms of ulcers - analgesics, antispasmodics.
An additional therapeutic effect on the foci of intestinal ulceration is provided by the use of drugs that ensure tissue regeneration.
Surgical intervention
Absolute indications for the use of surgical treatment methods are complications of the disease - bleeding, perforation or benign formations, provided that conservative therapy has not ensured a tendency to healing. During surgery, doctors excise or suture the ulcer.
Surgical treatment is not able to prevent recurrence of the pathology.
Folk remedies
To prepare the herbal mixture, take an equal amount of licorice root, chamomile flowers, marshmallow root and fennel fruit. The crushed raw materials are poured with boiling water and simmered in a water bath for about 15 minutes. Take a glass of decoction before bed.
Flax decoction provides a coating effect on the intestinal walls and thus protects the mucous membrane from irritating factors. Therefore, it is recommended to take a decoction of flax seeds before eating.
To achieve optimal therapeutic results, it is recommended to combine folk methods with traditional medicine.
Diet for duodenal ulcers
Diet therapy is an important component of a complex therapeutic effect on peptic ulcer disease. Changing the diet becomes especially important during periods of exacerbation.
Dietary nutrition involves fractional meals - in small portions up to 6 times a day.
The basis of the diet should be foods that do not irritate the intestines:
- well-cooked porridge from cereals - rice, oats, barley, corn;
- milk;
- low-fat weak broths;
- dried white bread;
- boiled or steamed meat and fish - low-fat varieties;
- vegetables and fruits containing soft fiber - cucumbers, zucchini, apples, bananas;
- cocoa with milk, weak tea.
In order for a diet for duodenal ulcers to have a positive effect, it is necessary to exclude from the diet fried, smoked and spicy foods, canned food, fatty meat and fish, vegetables containing coarse fiber - tomatoes, bell peppers, onions, mushrooms, strong drinks and alcohol, fermented milk products , sour fruits, berries and juices from them, as well as sparkling water.
How to prevent the appearance of peptic ulcers?
To avoid the development of peptic ulcers, it is necessary to adjust your lifestyle in such a way as to eliminate factors that increase the load on the stomach and intestines. Meals should be regular and balanced, sleep should be adequate, alcohol consumption should be minimal, and smoking should be stopped completely.
In addition, the risk of developing ulcers increases in people who often find themselves in stressful situations, get little rest or work at night.
At the slightest sign of digestive disturbances, it is better to immediately consult a doctor and not delay treatment until the peptic ulcer becomes chronic.
Duodenal ulcer is a chronic disease with a relapsing course, affecting the mucous membrane of the duodenum, in the form of a defect (ulcer), with further formation of a scar. Most often, duodenal ulcer is the result of chronic inflammation of its mucosa (chronic duodenitis). The disease is characterized by alternating periods of exacerbation (spring or autumn) and periods of remission (symptoms subside).
Increased secretion of hydrochloric acid or Helicobacter pylori infection are equally aggressive for both the duodenal mucosa and the gastric mucosa, therefore, duodenal ulcers are often associated with gastric ulcers.
According to statistics, duodenal ulcers occur in 5% of the population; young and middle-aged people are more likely to get sick. In men aged 25-50 years, the disease occurs 6-7 times more often than in women, perhaps this is due to drinking alcohol, smoking and neuro-emotional stress. In old age, the disease occurs equally in both sexes. Also, duodenal ulcer occurs in childhood, with a prevalence of about 1%.
Anatomy and physiology of the duodenum
The duodenum is the initial section of the small intestine, which starts from the pylorus of the stomach and ends at the junction with the jejunum. It received the name “duodenum” due to its length, as it has about 12 finger diameters. Its length is about 30 cm, the diameter of the widest part (ampull) is about 4.7 cm. The duodenum has the shape of a horseshoe, covering the pancreas, so it has several parts: the upper part, the descending part, the horizontal part and the ascending part (terminal section ). The upper part forms the ampulla of the duodenum, it is the initial section and starts from the pylorus of the stomach, it goes to the right and back, in relation to the stomach, forms a bend and passes into the next section of the intestine. The descending part, located to the right of the spinal column, descends down to the level of the 3rd lumbar vertebra, the next bend is formed, directing the intestine to the left and forming the horizontal part of the intestine. The horizontal part, after crossing the inferior vena cava and the abdominal aorta, makes a bend, rising up to the level of the 2nd lumbar vertebra; this part is called the ascending part of the duodenum.
The wall of the duodenum contains 3 membranes:
- Serosa, is the outer membrane, is a continuation of the serous membrane of the stomach;
- Muscularis, is the middle shell, consists of muscle bundles located in two directions, therefore it is represented by 2 layers: the outer layer is the longitudinal layer and the inner is circular;
- Mucous membrane, is the inner layer. In the upper part of the duodenum, the mucous membrane forms longitudinal folds, and in the horizontal and descending part, circular folds are formed. The longitudinal fold on the descending part ends with a tubercle, which is called the major duodenal papilla (Papilla of Vater), and at its apex the common bile duct and the pancreatic duct open. The flow of bile or pancreatic juice through the nipple of Vater into the duodenum is regulated by the sphincter of Oddi. Also, the mucous membrane of the duodenum forms cylindrical outgrowths, which are called intestinal villi. Each villi, in its central part, contains blood and lymphatic vessels that participate in the suction function. At the base of the villi, intestinal glands open, which produce duodenal juice (it contains enzymes necessary for digestion) and hormones (secretin, gastrin, cholecystokinin).
Functions of the duodenum
- Secretory function consists in the secretion of intestinal juice by the intestinal glands, which contains enzymes (enterokinase, alkaline peptidase and others) and hormones (secretin, gastrin, cholecystokinin) involved in digestion;
- Motor function, carried out by contracting the muscular layer of the intestine, as a result of which the chyme is mixed with digestive juice (intestinal juice, bile, pancreatic juice), it contains everything necessary for the final digestion of fats and carbohydrates received from food;
- Towing function, consists of evacuation (promotion) of intestinal contents into the following sections of the intestine.
Causes of duodenal ulcer formation
The development of an ulcer (defect) of the duodenal mucosa occurs through 2 main mechanisms:
- aggressive action of hydrochloric acid on the mucous membrane, resulting in increased acidity. The entry of acidic gastric contents into the duodenum leads to inflammation of areas of its mucosa, and the formation of a defect in the form of an ulcer;
- infectious factor (Helicobacter Pylori), a bacterium with an affinity for the epithelium of the digestive system (stomach, duodenum). Helicobacter Pylori infections entering the digestive tract can remain for many years, attaching themselves to the mucosal wall with their flagella, without causing any clinical manifestations. As it multiplies, the bacteria releases harmful substances that lead to the death of cells in the duodenal mucosa, followed by the development of a defect. Also, Helicobacter Pylori increases acidity by releasing ammonia.
Risk factors for developing duodenal ulcers
- Factors leading to increased acidity of gastric contents:
- Abuse of strong coffee;
- Disturbed diet with long breaks between meals;
- Abuse of foods that increase acidity (spicy foods, smoked foods, saltiness, fermentation and others);
- Presence of pre-ulcerative condition (chronic gastritis);
- Nervous-emotional stress;
- Genetic predisposition to increased secretion of gastric juice.
- Factors that have a destructive effect on the cells of the duodenal mucosa that do not depend on acidity:
- The bacterium Helicobacter Pylori, which is transmitted through the saliva of an infected person;
- Frequent use of certain groups of medications: non-steroidal anti-inflammatory drugs (Aspirin, Ibuprofen and others), glucocorticoids (Prednisolone) and others.
Symptoms of duodenal ulcer
Symptoms of peptic ulcer disease most often appear during an exacerbation period (most often in spring or autumn).
- Pain of a piercing, cutting nature in the upper abdomen, radiating to the right hypochondrium, to the back. The development of pain is associated with eating food, most often it appears 1.5-2 hours after eating. The appearance of pain is associated with the irritating effect of acidic gastric contents on the damaged mucous membrane of the duodenum. Also characteristic are night pains that appear as a result of increased secretion of hydrochloric acid after dinner. Some patients may experience hunger pains that develop as a result of prolonged fasting; they decrease within a few minutes after eating. To relieve pain, you need to take antacids (Almagel, Maalox, Reni);
- Dyspeptic disorders in duodenal ulcers occur less frequently compared to gastric ulcers. These include: nausea, vomiting, bloating, heartburn, belching and constipation, which develop as a result of increased acidity and impaired digestion;
- Lack of appetite, due to severe pain and dyspeptic syndrome, as a result of which patients begin to lose weight and lose weight.
In some patients, duodenal ulcer may manifest itself only in the form of dyspeptic disorders, there is no pain.
Complications of duodenal ulcer
All complications of duodenal ulcer are severe and life-threatening for the patient, they lead to the development of an acute abdomen, and therefore require urgent surgical intervention:
- Perforation of the ulcer, through all the walls of the intestine, and communication of the ulcerative surface with the abdominal cavity. This complication is accompanied by the development of peritonitis, the main manifestation of which is acute dagger pain in the abdominal cavity;
- Bleeding from an ulcer, develops as a result of erosion of the wall of the duodenal vessel at the level of the ulcerative surface. The main manifestation of this complication is melena (blood in the stool);
- Ulcer penetration, penetration of an ulcer through the wall of the duodenum into the pancreas, accompanied by acute pancreatitis;
- Duodenal stenosis, develops as a result of the formation of a large scar, which prevents the further movement of chyme into the intestines. One of the main manifestations is vomiting full mouth;
- Periduodenitis, develops as a result of reaching the zone of inflammation around the ulcer, the serous membrane of the duodenum;
- Ulcer malignancy, is rare, malignancy of mucosal cells in the area of the ulcerative surface occurs, followed by the development of a malignant tumor.
Diagnosis of duodenal ulcer
Diagnosis of duodenal ulcer is made by carefully collecting anamnesis (nature of pain, localization, history of chronic gastritis or duodenitis, hereditary predisposition, manifestation of the disease associated with seasonality).
An objective examination of the patient, using palpation of the abdomen, confirms the presence of a pathological process at the level of the duodenum.
Accurate confirmation of the diagnosis is carried out using the following instrumental research methods:
- Determination of antibodies toHelicobacter pylori in the patient's blood;
- pH - metry (determination of gastric juice acidity), determines one of the main reasons for the development of ulcers, which is increased secretion of hydrochloric acid;
- X-ray examination of the duodenum, reveals the following characteristic signs:
- niche symptom - manifests itself in the form of retention of the contrast agent in the area of the defect in the duodenal mucosa;
- index finger symptom, characterized by retraction of the duodenal mucosa on the opposite side to the ulcer;
- ulcer shaft - characteristic of the area of inflammation around the ulcer;
- cicatricial-ulcerative deformation of the wall of the duodenum, characterized by the direction of the folds of the mucous membrane around the ulcer, in the form of a star;
- accelerated and delayed evacuation of contrast agent from the duodenum;
- Detects the presence of possible complications (ulcer perforation, penetration, duodenal stenosis).
- Endoscopic examination (fibrogastroduodenoscopy), This method consists of examining the mucous membrane of the duodenum using a fibrogastroduodenoscope. Using this research method, it is possible to determine the location of the ulcer, its exact size, and possible complications (including bleeding from the ulcer).
- Microscopic examination biopsy of the mucous membrane of the duodenum, taken during fibrogastroduodenoscopy, for the presence of Helicobacter Pylori.
Treatment of duodenal ulcers
At the first suspicion of duodenal ulcer, it is necessary to seek medical help for examination and necessary treatment, to prevent possible dangerous, rapidly developing complications that are much more difficult to cure. For the treatment of duodenal ulcers, special 3 or 4 component treatment regimens have been developed that prevent the progression of the disease. The attending physician selects a treatment regimen for each patient individually, depending on the cause of the disease and the results of the study. Treatment medications can be taken in tablet form and by injection. Usually the course of treatment lasts for 14 days.
Drug treatment of duodenal ulcers
Groups of medications that are used to treat duodenal ulcers:
- Antibiotics are used to eradicate (destruct) Helicobacter pylori infection:
- Macrolides (Erythromycin, Clarithromycin). Clarithromycin tablets are used 500 mg, morning and evening, after meals;
- Penicillins: Ampiox is prescribed 500 mg 4 times a day, after meals;
- Nitroimidazoles: Metronidazole, prescribed 500 mg 3 times a day, after meals.
- To eliminate pain by reducing the secretion of hydrochloric acid apply:
- Bismuth preparations (De-nol) have both an astringent mechanism for the gastric mucosa and a bactericidal effect against Helicobacter Pylori. De-nol, prescribed 120 mg 4 times a day, 30 minutes before meals.
- Proton pump inhibitors: Omeprazole, prescribed 20 mg 2 times a day, before meals;
- H2 receptor inhibitors: Ranitidine, prescribed 150 mg 2 times a day, before meals.
- Drugs that relieve pain by forming a protective film on the duodenal mucosa:
- Antacids (Almagel, Algel A, Almagel Neo, Maalox). Almagel is prescribed to drink 1 tablespoon 30 minutes before meals.
Surgery duodenal ulcer
It is performed rarely or for ulcerative complications. It involves removing the affected area of the intestine or cutting the nerve branches of the vagus nerve, thereby reducing gastric secretion and reducing the level of hydrochloric acid.
Diet for duodenal ulcer
All patients with peptic ulcer disease must strictly follow a diet, adhere to a diet, eliminate nervous stress if possible, and give up alcoholic beverages and smoking. Food for patients with peptic ulcers should be finely ground (not coarse), warm (neither hot nor cold), not salty, not greasy and not spicy. The patient should eat about 5 times a day, in small portions, the total daily calorie content should be about 2000 kcal. The food should be boiled or steamed. It is good to drink hydrocarbonate waters and soothing teas, these include: Borjomi, Essentuki No. 4, mint or lemon balm tea and others.
Foods and dishes that can be consumed for peptic ulcers:
- Dairy products (milk, low-fat cottage cheese, low-fat sour cream, kefir);
- Low-fat fish or dishes made from it (pike perch, perch and others);
- Low-fat meats (rabbit, chicken, veal);
- Various types of porridge (buckwheat, oatmeal, rice and others);
- Crackers and dried bread;
- Vegetables and fruits, fresh or boiled (red beets, potatoes, carrots, zucchini);
- Dishes prepared with vegetable oils (olive, sea buckthorn and others);
- Light vegetable soups;
If you have a peptic ulcer, you should not consume:
- Fried food;
- Salty food;
- Spicy dishes;
- Fruits that increase acidity in the stomach (citrus fruits, tomatoes, and others);
- Smoked meats;
- Various canned foods;
- Fatty meats and fish (pork);
- Pickled foods (sauerkraut, tomatoes, cucumbers);
- Rye bread and bakery products made from butter dough.
Prevention of duodenal ulcers
Prevention of duodenal ulcer has 2 goals: preventing increased secretion of hydrochloric acid and preventing infection with Helicobacter pylori infection. In order to prevent an increase in hydrochloric acid, it is necessary to give up alcoholic beverages and smoking, eliminate neuro-emotional stress, while eating, exclude from your diet foods that increase acidity (spicy, salty, fried). In order to prevent infection with Helicobacter pylori infection, it is necessary to use clean utensils (do not drink from a cup after someone else, do not use someone else’s spoon or fork, even with your family), since this infection is transmitted through the saliva of an infected person. In the presence of chronic gastritis and/or duodenitis, their timely drug treatment and diet therapy.
What is a perforated duodenal ulcer, signs and symptoms?
Duodenal ulcer called erosive damage to the mucous membrane of the initial part of the small intestine. Duodenum(Latin - Duodenum) is the first and closest to the stomach section of the small intestine, horseshoe-shaped, encircling the pancreas. This section of the gastrointestinal tract plays a very important role in the digestion process, since partially digested food enters here immediately after passing through the stomach, and it is also where the ducts from the gallbladder and pancreas open. Such a large accumulation of various secretions necessary for the process of digestion and assimilation of food contributes to the fact that ulcerative defects often form in this area.
Among the symptoms of duodenal ulcer, the main one, without a doubt, is pain, the nature, location and frequency of which can become a support in the diagnosis of this disease. With this disease, the pain is localized in the epigastric region, that is, above the navel. It is acute in nature and appears, as a rule, 1.5-3 hours after the last meal, when food passes from the stomach to the duodenum. A distinctive feature of this disease is also “hunger pain,” that is, pain that occurs during a long break in nutrition and subsides immediately after eating.
Perforated (or perforated) An ulcer is called if its depth increases so much that at a certain moment it passes through the entire thickness of the wall of the duodenum, forming a through defect through which the contents of the digestive tract exit into the abdominal cavity, causing serious complications. Perforation of an ulcer is considered one of the most dangerous defects that occurs with peptic ulcer disease.
Perforation of the ulcer is characterized by a sharp deterioration in the patient’s well-being and is accompanied by acute unbearable pain, vomiting, a hard abdomen due to muscle contraction, rapid heartbeat and shallow breathing. If peritonitis occurs, caused by the contents of the gastrointestinal tract entering the abdominal cavity, signs of acute intoxication of the body may appear, such as confusion, fever, cold sweat, chills, and low blood pressure. This condition is considered life-threatening and requires immediate medical attention.
What types of treatment for duodenal ulcers exist?
There are 4 types of treatment for duodenal ulcers - non-medicinal, with the help of medications, endoscopic and surgical.
Towards non-drug treatment This includes diet therapy, as well as the elimination of all factors that weaken the body’s defenses and provoke the occurrence of ulcers. Such factors are smoking, alcohol consumption, incorrect and unreasoned use of non-steroidal anti-inflammatory drugs or other medications, constant stress and overexertion, as well as poor lifestyle and nutrition. Without eliminating the listed factors, as well as without a well-chosen diet, no other type of treatment will give the desired results. Diet and a healthy lifestyle are key factors in the recovery process for this disease.
Endoscopic treatment consists of local impact on the ulcerative defect using an endoscope. This treatment method is local and is carried out against the background of complex drug and non-drug therapy. During endoscopic treatment, pieces of dead tissue are removed from the ulcer, antibiotics are administered, and drugs are used that can speed up the healing process and restore tissue viability. If the patient complains of severe pain, endoscopic treatment involves blocking the nerve endings, which helps to alleviate the patient’s condition.
Surgery indicated if other types of therapy have failed, as well as in the presence of serious complications, such as perforation of the ulcer or severe bleeding. This method of treatment is considered radical, and consists of removing the affected area of the digestive tract along with part of the tissues that produce hydrochloric acid, as well as eliminating the complications accompanying peptic ulcer disease.
Medications for peptic ulcers, they are prescribed by a doctor and meet the principles of safety, tolerability, treatment effectiveness, as well as simplicity of drug regimens and reasonable cost of treatment. For duodenal ulcers, combination drug therapy is recommended, that is, the treatment regimen includes several drugs at once, the combination of which gives the most positive result.
The most common treatment regimen for peptic ulcer disease is triple therapy or a combination of three drugs:
Drug No. 1 | Drug No. 2 | Drug No. 3 |
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Name of pharmacological group | Proton pump inhibitors (PPIs) | Macrolides | Penicillins | Nitroimidazole derivatives |
Short description | This group belongs to antisecretory drugs, since its main function is to reduce the production of hydrochloric acid, which is one of the most powerful aggressor factors causing the formation of ulcers. This group is the most frequently used in the treatment of diseases of the digestive tract. | Penicillins are a group of antibiotics with a fairly broad spectrum of action. However, due to the fact that this group of drugs often provokes allergic reactions, and also because bacteria often become resistant to drugs in this group, Amoxicillin is often replaced by Metronidazole in triple therapy for ulcers. | If taking amoxicillin is contraindicated, then the third drug in this treatment regimen is Metronidazole. This is one of the most important antimicrobial drugs that primarily affects anaerobic bacteria. |
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Representatives of the group suitable for the treatment of ulcers | Omeprazole, Pantoprazole, Lansoprazole, Esomeprazole, etc. | Clarithromycin | Amoxicillin | Metronidazole |
Mode of application | Triple therapy involves taking one of the PPI drugs. Representatives of this group are taken 2 times a day, the dosage depends on the drug: Omeprazole - 20 mg, Pantoprazole and Esomeprazole - 40 mg, Lansoprazole - 30 mg. The duration of treatment is, on average, 7-14 days. | This drug is taken 2 times a day, 500 mg. The duration of treatment is 7-14 days. | This drug is taken 2 times a day, at a dosage of 1000 mg. The course of treatment is 7-14 days. | This drug must be taken 2 times a day, 500 mg. The duration of treatment is 7-14 days. |
According to studies, triple therapy demonstrates effectiveness in 70% of cases. The presence of antimicrobial drugs and antibiotics in this treatment regimen is explained by the fact that the occurrence of peptic ulcers is often caused by the presence of Helicobacter pylori infection in the gastrointestinal tract, which is one of the factors provoking the formation of ulcers. If the patient has an infection resistant to antibiotics, the triple treatment regimen is divided into 2 stages and is called "stepped" or "sequential" therapy. This division into stages somewhat increases the effectiveness of triple therapy. Its essence lies in taking the same drugs that are included in triple therapy, but not simultaneously, but in 2 stages:
- The first stage - for 5-7 days it is necessary to take the recommended dose of one of the PPI drugs (for example, Omeprazole) 2 times a day, as well as the antibiotic Amoxicillin, at a dosage of 2000 mg per day, divided into 2-4 doses;
- The second stage - for 5-7 days one of the PPI drugs is taken in the same dosage, 2 times a day, together with Clarithromycin, 500 mg 2 times a day, and with Metronidazole, 500 mg 2-3 times a day.
In the event that triple therapy does not bring the desired result, as well as in the presence of high resistance of microorganisms to triple therapy drugs, there is an alternative regimen called "quad therapy". This treatment regimen is considered the most effective tactics for drug treatment of duodenal ulcers.
A drug | Effect of the drug | Mode of application |
Decreased production of hydrochloric acid in the stomach | 2 times a day 20-40 mg |
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De-Nol (Bismuth tripotassium dicitrate) | Antibacterial effect, anti-inflammatory effect, increasing the resistance of the mucous membrane to the action of hydrochloric acid, accelerating the healing process of ulcers | 240 mg 2 times a day |
Tetracycline | Antibacterial drug with a wide spectrum of action | 500 mg 4 times a day |
Metronidazole | Antimicrobial action | 3 times a day 500 mg |
The total duration of taking medications during quadruple therapy is 10 days.
What is the diet during an exacerbation of a duodenal ulcer?
Strict adherence to a diet in the presence of a duodenal ulcer is a prerequisite for therapy and the key to a quick recovery. In the treatment of this disease, Pevzner’s “anti-ulcer” diet, also called Diet No. 1, has become widespread. This diet includes several subtypes, each of which is prescribed at a certain stage of the disease, and, depending on the course of the disease, one subtype of diet smoothly transitions into another. During an exacerbation of peptic ulcer disease, the diet should be more gentle and light, while the remission stage does not require additional mechanical processing of foods. Thus, the diet option prescribed during acute periods of the disease was called Diet No. 1A or the “gentle” diet, and the nutrition option for the remission stage or during the recovery stage was called Diet No. 1 or the “mashed” diet. The transitional stage from one subtype of diet to another is called Diet No. 1B.
When compiling these diets, the body's needs for nutrients, adherence to a certain rhythm of food intake, as well as the need for mechanical, thermal and chemical sparing of the mucous membrane of the stomach and duodenum were taken into account. Mechanical sparing consists of both careful culinary processing of food and a balanced combination of products and dishes. Thermal sparing involves controlling the temperature of food taken, which should not be lower than 15°C or higher than 55°C, since very hot or very cold food has an irritating effect on the mucous membrane of the digestive tract and reduces its resistance to aggressor factors. Of greatest importance is the principle of chemical sparing, which includes careful processing and a combination of products that do not cause excessive formation of gastric juice and quickly pass through the digestive tract.
Compliance with therapeutic diet No. 1 involves eating small portions, 4-5 times a day. Meals are distributed evenly throughout the day, and the size of portions should increase from the first meal to lunch and decrease from lunch to the last meal. It is not recommended to eat too large portions at one time, and you should not take your last meal just before bed. The liquid consumed during the day also plays an important role. It should be at a warm temperature, rich in mineral salts that reduce the acidity of gastric juice (for example, carbonates), and its volume should be at least 1.5 liters per day.
What foods to choose for duodenal ulcers?
It has long been believed that stress and poor diet cause ulcers. However, it has already been reliably proven that most ulcers are caused by the bacterial infection H. pylori. It follows from this that there are no foods that cause ulcers; food only creates a favorable or unfavorable environment for the growth of bacteria. Proper nutrition is aimed at reducing stomach acidity, thereby helping to reduce the symptoms of the disease and speed up the healing process of ulcers.
The modern approach to the diet for duodenal ulcers is that there is NO strict SINGLE diet, everything is very individual. However, some principles must be followed, namely, do not eat foods that increase stomach acidity and foods that make you feel uncomfortable.
Principles:
- Alcoholic beverages should be avoided
- Limit the consumption of caffeine-containing drinks such as coffee, tea, cocoa, cola.
- Do not consume large amounts of milk, as this leads to increased stomach acidity. No more than 1-2 cups of milk per day.
- The use of seasonings and spices does not affect the healing process of the ulcer. However, their use can cause heartburn and other discomfort. You should avoid consuming large amounts of spices such as black pepper, chili pepper, red pepper, onion, garlic - if they cause discomfort.
- Eating small, frequent meals helps some people.
- The most important thing to remember is that only you can judge what you tolerate and what you don’t. Listen to your body and stick to the golden mean.
We offer the most suitable products for this disease, but remember the choice is always yours.
Soups and liquid cereals can become the basis for your diet when following an anti-ulcer diet. Porridges should be pureed and soupy; preference should be given to rice, buckwheat and semolina cereals. They are prepared with milk or with the addition of cream. Boiled vermicelli in milk is also allowed with this diet. Soups in this diet, as well as porridges, are recommended to be prepared by adding milk, cream or butter. This way they become more viscous or “slimy”, representing one of the most gentle dishes for the digestive tract. Soups should not be prepared with meat or fish broth, but pureed or chopped vegetables can be added when switching from diet No. 1A to diet No. 1B. The basis of soups for this diet is usually rice or oatmeal, as well as small vermicelli or chopped noodles.
Meat and fish If you follow this diet, you should consume it in small quantities, after careful mechanical and thermal processing, giving preference to boiling or steaming, removing all fat, skin and veins from the meat. You should strictly exclude any fatty meats and fish, as well as any dishes with half-baked or raw meat or fish. If you follow a more strict version of the diet (diet No. 1A), you should not include whole pieces of meat in the menu; steamed soufflés, cutlets, meatballs, etc. are much preferable.
Vegetables and fruits, just like meat, must undergo mechanical processing, they should be consumed in the form of purees, steamed, baked or boiled. Vegetables such as beets, carrots, and zucchini are allowed. You can also add pumpkin, sweet apples, pears and other sweet varieties of fruits and berries to the dish. Acidic fruits and vegetables should be excluded from the menu, as they increase the acidity of gastric juice. At the stage of exacerbation of the disease, vegetables and fruits should be completely abandoned.
Dairy and eggs
It has been proven that milk increases the acidity of the stomach, which thereby increases the aggravation and slows down the healing process of ulcers. In this regard, it is recommended to limit the intake of milk and dairy products. You should abstain from fermented milk products, and it is also not recommended to eat fried hard-boiled eggs, preferring soft-boiled eggs. Omelettes should be prepared with the addition of dairy products or butter.
Use baked goods and sweets should be limited, they can be included in the diet when transitioning from the more strict diet No. 1A to diet No. 1. Fresh baked goods should not be included in the menu, but dried bread, biscuits or cookies are allowed in limited quantities. You should refrain from eating black bread, muffins and buns. For sweets, preference is given to light, low-fat desserts such as fruit jelly, marmalade, and marshmallows. Any dessert based on a biscuit or with the addition of cream is excluded from this diet.
What is an approximate menu for a duodenal ulcer?
First meal should be the lightest, but nevertheless nutritious and balanced. The most successful breakfast option is buckwheat or rice porridge with milk, soft-boiled eggs or steamed omelet, pureed cottage cheese with milk or cream, as well as a light cottage cheese casserole. It is recommended to drink weak tea with milk or cream, but you should avoid coffee while on a diet.
Lunch it should also be easy and useful. For this meal, you can choose pureed cottage cheese, a baked apple, a glass of whole milk or decoctions based on sweet fruits and berries.
Dinner is the main meal of the day in this diet; it contains the most voluminous and nutrient-rich dishes. Lunch should consist of three courses - soup, main course and dessert.
Soup options | Main course options | Dessert options |
Milk soup with pureed rice | Steamed meatballs with vegetable puree | Fruit jelly |
Slimy semolina soup | Meat soufflé with mashed potatoes | Fruit decoction |
Milk soup with small boiled vermicelli | Fish cutlets with grated buckwheat | Sweet berry jam |
Milk soup with pureed buckwheat | Boiled fish with pureed rice porridge | Marmalade |
Afternoon snack includes the same dishes as second breakfast. It should be light and the portions should be small. A good choice for an afternoon snack are crackers or dry cookies with fruit compote, pureed cottage cheese, a baked apple or just a glass of milk.
Dinner is the last meal, it should be included in the daily routine no later than 2 hours before going to bed. A suitable dish for dinner could be boiled fish, meat in the form of cutlets, meatballs or zraz, meat souffle, lazy dumplings. A good side dish can be vegetable puree, pureed porridge with milk, or boiled chopped noodles.
During the day Don't forget about liquid. Warm mineral water, tea with milk, rose hip decoction and fruit compote can be drunk throughout the day. It is also recommended to drink a glass of milk at night.
Sample menu for one day |
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250 grams of whole grain flakes; 150 ml skim milk; 1 cup of herbal tea. |
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6 whole grain crackers 50 grams of low fat cheese |
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80-10 grams of turkey with spinach; 2 slices of whole grain bread; 1 pear (without peel); Raspberry tea. |
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1-2 teaspoons peanut butter; 1 slice of whole grain bread; 1 apple (preferably without peel, not sour). |
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120-170 grams of baked salmon; 1-2 baked potatoes or 100-150 grams of brown rice; 1 slice of whole grain bread; |
Always remember that each body is very individual and what suits one may not suit another. Examine your body, listen to it and be sure to consult with your doctor.
Is it possible to drink alcohol if you have a duodenal ulcer?
Alcohol is one of the aggressor factors that causes serious harm to the gastrointestinal tract. It disrupts the integrity of the protective layer of mucus of the stomach and duodenum, damages the mucous membrane of the digestive tract, reduces the ability of tissues to recover, and also disrupts the functioning of local protective factors. In addition to the direct effect on the digestive system, alcohol has a negative effect on the body as a whole, reducing its immunity, disrupting the balance of vitamins and microelements, causing disruptions in the functioning of the nervous, hormonal and other systems.
According to some studies, there is a direct relationship between systematic alcohol consumption and the incidence of digestive tract diseases. Alcohol contributes to the appearance of gastritis, peptic ulcers, liver cirrhosis and other diseases. If you have a peptic ulcer, even a small portion of alcohol can provoke an exacerbation of the disease and the appearance of serious complications. Therefore, drinking any alcoholic beverages for duodenal ulcers is strictly contraindicated.
Some scientists claim that drinking red wine in small quantities may have a beneficial effect in treating peptic ulcers, but no hard evidence has yet been found to support such claims. In addition to the direct negative impact on peptic ulcers, red wine can reduce the effectiveness of medications taken to treat this disease. Therefore, most doctors still adhere to the principle of excluding any alcoholic beverages when treating diseases of the gastrointestinal tract.
Is persimmon good for duodenal ulcers?
Persimmon is considered a valuable product, rich in nutrients, vitamins and microelements. This fruit also has a certain bactericidal effect, which is its advantage over other fruits. Persimmon contains a lot of vitamins A, C and P, carotene, iodine, magnesium, potassium and iron.
Diet No. 1A, indicated at the stage of exacerbation of the disease, excludes the consumption of any vegetables and fruits, as they can have an irritating effect on the mucous membrane of the stomach and duodenum. Therefore, the inclusion of persimmon in the diet during acute disease is not recommended. However, at the stage of remission and during the recovery process, when diet No. 1A smoothly flows into diet No. 1, persimmon can be included in the diet in small quantities. It has a mild antibacterial and analgesic effect, and also has a positive effect on the functioning of the digestive tract and intestinal microflora. The rich content of vitamins and microelements in persimmons contributes to faster restoration of damaged tissues and recovery.
It should be remembered that in case of duodenal ulcer, the persimmon should be absolutely ripe, the fruit should be soft and sweet, it should be eaten pureed, in small quantities. If you have diabetes, chronic constipation, or chronic kidney and bladder diseases in the acute stage, you should refrain from eating persimmons.
Is sea buckthorn oil useful for duodenal ulcers?
Sea buckthorn oil is known for its beneficial properties and high content of vitamins and minerals. It contains a large amount of vitamin A, B, C and E, calcium, magnesium, fatty and fruit acids, carotenoids, etc. This oil has found wide application in the field of cosmetology and medicine. It helps improve immunity, rapid healing of wounds, has an anti-inflammatory effect, improves blood circulation, improves vision, restores the balance of hormones and microelements in the body, and also reduces blood sugar and cholesterol levels.
For peptic ulcers, sea buckthorn oil is recommended to be taken 30 minutes before meals, in small quantities, one teaspoon. You can start with twice a day, gradually increasing the frequency of administration, provided that it is well tolerated. Sea buckthorn oil is involved in the regulation of stomach acidity, creates a protective film on the mucous membrane of the digestive tract, reducing the impact of irritating factors, improves blood supply to tissues and accelerates the process of recovery and regeneration. Sea buckthorn oil also has an anti-inflammatory effect, thus promoting the transition of the disease from the acute stage to the remission stage. If you have diseases of the pancreas, liver or gall bladder, you should consult your doctor before consuming sea buckthorn oil.
An ulcer is a disease that causes damage to the gastric mucosa. It refers to chronic diseases.
People of all ages suffer from ulcers, but in most cases, those at risk are between the ages of 20 and 50. Exacerbations occur in spring and autumn.
There are several types of ulcers. Treatment of gastric and duodenal ulcers should be carried out in a timely manner.
Symptoms
The first signs appear as follows: the appearance of acute pain in the stomach, which can radiate to the lumbar region.
If there is a stomach ulcer, painful sensations occur, in most cases, after eating, and with a duodenal ulcer they appear on an “empty” stomach or at night.
Sometimes additional nausea, vomiting or heartburn occurs. Very often with this disease a person experiences constipation.
If you have a stomach or duodenal ulcer, bleeding and black stool may occur.
There are also so-called “silent” ulcers. It goes away, in most cases, with certain symptoms and is detected much later, when bleeding appears.
Symptoms of gastric and duodenal ulcers are the same for all patients. This is constant intense pain in the stomach area. They can bother the patient for a very long time.
Exacerbations occur in the spring-autumn period. Ulcer pain occurs due to cramps in the stomach and irritation of the stomach wall where the ulcers are located.
They can be of varying intensity, depending on the duration of the disease and the degree of damage to the organ.
Reasons for appearance
Stressful situations play the most important role in the occurrence of stomach and duodenal ulcers.
They contribute to a decrease in the protective properties of the body, poor circulation and spasms in the functioning of the gastrointestinal tract.
Improper nutrition leads to the fact that hydrochloric acid does not eliminate bacteria from food, but begins to damage the walls of its own stomach.
That is, the problem in the functioning of the internal organs is that gastric juice begins to have an adverse effect and an imbalance arises between the factors of aggression and the protective properties of the stomach.
Other reasons that lead to ulcers:
- Having bad habits.
- Chronic diseases of the gastrointestinal tract. For example, cholecystitis, pancreatitis, gastritis, duodenitis.
- Poor nutrition.
- If a person has been using medications for a long time. Especially if these are non-steroidal anti-inflammatory drugs. Stomach ulcers can occur as a result of side effects from taking the pills.
- Heredity.
- The presence of the bacterium Helicobacter pylori. Nine out of ten people suffer from duodenal ulcers for this reason.
In medicine, there is such a diagnosis as symptomatic peptic ulcers.
They appear as a result of stressful situations, disruption of the nervous system, liver cirrhosis, burns, kidney failure. This disease is very rare.
Diagnostics
The most effective method for diagnosis is fibrogastroduodenoscopy.
Using a visual examination of the gastric mucosa, you can determine the presence of a stomach ulcer, as well as take a biopsy of the mucosa to determine the presence of benign or malignant tumors.
It is necessary to donate blood for the presence of the Helicobacter pylori bacterium, hemoglobin and leukocyte levels. Diagnosis also involves determining the level of acidity of gastric juice.
Only after this can the doctor determine the necessary treatment.
Treatment
In order to treat stomach and duodenal ulcers, it is necessary to take medications. You can additionally use traditional methods. It is important to follow a diet.
Drug therapy may consist of the following drugs:
- Medicines that are proton pump blockers. They are necessary to normalize the acidity of gastric juice. For example, Omeprazole, Lansoprazole.
- Medicines necessary to protect the mucous membrane. Phosphalugel, Maalox, Almagel.
- Drugs that help normalize gastric juice for internal use: Famotidine, Ranitidine.
- Additionally, it is recommended to use antidepressants to eliminate problems with the nervous system and the effects of stress.
After the acute symptoms have been eliminated, it is necessary to destroy the Helicobacter pylori bacteria.
Rehabilitation therapy takes place in three phases:
- Drug to eliminate Helicobacter pylori: Metronidazole.
- Antibiotics: Clatriromycin, Amoxicillin.
- Medicines based on Bismuth. For example, De-Nol.
It is necessary to take the drugs in a course lasting 2 weeks. But when taking antibiotics, it is necessary to take yogurt or special bacteria to normalize the functioning of the gastrointestinal tract.
Gastric and duodenal ulcers can be healed with the help of medications. But it is very important not only to take medications, but also to give up bad habits.
You should not drink coffee, very hot or cold food, alcoholic beverages, and try to eliminate stress from your life.
If the disease is not treated in the required time, then deterioration in health is possible.
For example, stenosis of the stomach or duodenum, bleeding, the formation of first a benign and then a malignant tumor at the site of an ulcer.
If for a long time the symptoms of a stomach and duodenal ulcer are not eliminated with the help of medications or the process even worsens, then there may be a need for hospitalization.
It is treatment under the supervision of a physician or the use of surgery to remove the area of the stomach or duodenum that has been affected.
After the operation has been performed, it is necessary to take anti-ulcer medications for a long time. The patient is discharged on day 5 if there are no complications.
He has been on bed rest at home for approximately the same amount of time. A quick recovery after surgery is possible if a person follows a diet.
It must be followed for two months. At this time, it is recommended not to abuse salt, large amounts of liquid and quickly digestible carbohydrates.
On the second and third days after surgery to eliminate stomach and duodenal ulcers, you must take non-carbonated mineral water and weak green tea.
Upon arrival home, a person can drink rosehip decoction, eat 1 boiled egg, as well as buckwheat porridge or boiled vegetables.
After a while, you need to eat cutlets made from lean meat or steamed fish.
Bread is allowed to be consumed no earlier than a month after the operation. At first, it is forbidden to consume honey, coffee, cocoa, and ice cream.
Dishes that are not suitable for consumption cannot be prepared from: spinach, mushrooms, onions, cabbage, garlic, radishes.
During the period of exacerbation of the disease, it is necessary to treat the person in a hospital. Treatment is prescribed for 2-3 weeks, during which time it is necessary to avoid physical activity and various nervous shocks.
You need to take food in small quantities several times a day. Additionally, you can use mud therapy, reflexology, UHF therapy and treatment with paraffin applications.
For acute pain, it is necessary to take medications to eliminate spasms.
Treatment with folk remedies
Ulcers of the stomach and duodenum require special attention. It must be cured completely, and not just eliminate the symptoms.
To do this, it is advisable to use not only medications, but also traditional medicine methods. They have no side effects and help eliminate the first signs of the disease.
- A very effective remedy is the use of a decoction of yarrow. You need to take 50 grams of grass and add 200 grams of hot boiled water. It is advisable to place in a dark place and leave to infuse for 60 minutes. It is advisable to consume 100 grams before meals. This decoction must be taken to relieve symptoms if there is an ulcer.
- You need to combine onions and water. Drink half an hour before eating if you have an ulcer.
- Combine 500 grams of butter and the same amount of honey. Both ingredients must be in liquid form. Separately, you need to grind a glass of walnut partitions using a blender. It is advisable to consume the resulting mixture on an empty stomach.
- To prevent the occurrence of ulcers, it is necessary to consume aloe leaves half an hour before meals. A piece of leaf should be chewed well, the aloe juice should be swallowed, and the sides of the leaf should be spat out. The course must be carried out for 3 months or to eliminate the symptoms.
- You need to take potato tubers and turn them into a paste using a blender. Treatment occurs through the use of juice. It should be taken before breakfast and lunch.
- Flax seeds are very good for the functioning of the gastrointestinal tract. They can be purchased at a pharmacy or supermarket. They help eliminate symptoms, relieve pain and gently envelop the walls of the stomach.
Diet
What foods can you eat if you have an ulcer? For example, you can eat no more than 2 boiled eggs per day. They can be steamed and used for preparing other dishes.
You can prepare dishes from cereals and pasta. These can be porridges, purees, puddings. They can be cooked by steaming or simply in water.
For sweets, it is advisable to give preference to ripe berries and fruits, but not sour ones. They can be consumed in any form, baked, steamed or raw.
Dairy products can also be taken. Grind the cottage cheese using a blender until smooth. Drinks include tea with milk or sweet juices.
You can enrich the body with a large number of microelements using rosehip decoction.
It is necessary to completely exclude the following foods:
- Fatty meats. Smoked meats.
- Smoked or canned fish.
- Vegetables you should not eat include white cabbage, mushrooms, radishes, sorrel, and cucumbers.
- Tomato, fish, meat, mushroom sauces. It is also necessary to limit the amount of horseradish, pepper and mustard you consume.
- You should absolutely not drink carbonated drinks, black kvass or coffee.
- Eating fresh bread, especially white bread. You should also not eat baked goods.
Useful video
Update: October 2018
Duodenal ulcers often begin gradually with sucking pain in the pit of the stomach, an increased feeling of hunger in the morning, and mild nausea.
But just as often, these signals that the body gives are not taken seriously. The person simply does not realize the scale of the impending problem. After all, persistent pain syndrome, as well as dangerous complications of this disease, develop much later.
If there is the slightest doubt about the presence of the disease, you should immediately contact a therapist or gastroenterologist with complaints, so as not to end up with a surgeon or, God forbid, a pathologist.
To help you navigate the variety of manifestations of duodenal ulcer, this article collects and highlights the main issues related to this disease.
What is an ulcer?
The wall of the duodenum, which is called duodenum in Latin, consists of mucous, submucosal and muscular layers. An ulcer is a wall defect, the bottom of which is located in the muscle layer, that is, the mucosa and submucosa are destroyed.
In the duodenum, the ulcer is most often located in the initial section (bulb or bulb), since here are the most favorable conditions for the reflux of acidic gastric contents and a wonderful place for the proliferation of bacteria that provoke peptic ulcer disease. Sometimes not one ulcer of the duodenal bulb is formed, but several at once. More often these are paired, opposite each other, “kissing” ulcers.
Peptic ulcer disease is the repeated formation of ulcerative defects in the wall of the duodenum, occurring with periods of exacerbation (the presence of an ulcer) and remission (the absence of an open defect in the intestinal wall). Since the ulcer heals with the formation of a scar, even in remission, scar defects remain on the mucous membrane. If exacerbations are frequent and a lot of scars are formed, they can deform or narrow the intestinal lumen.
About ten percent of the world's population suffers from duodenal ulcers. These are predominantly young and middle-aged people.
Why does she appear?
There is no single view on the occurrence and development of duodenal ulcers. There are several equivalent theories of the occurrence of ulcers.
- On the one hand, several years ago there was a very popular assumption that peptic ulcer disease is the result of the colonization of the stomach and intestines by a microbe such as Helicobacter pylori. The microbe infects cells that secrete mucus. During development, it quickly colonizes the stomach and duodenum, stimulating the release of gastrin and releasing cytokines (substances that damage cells). Later it turned out that not all types of this microorganism living in humans cause disease. Therefore, blaming everything on infection is still wrong.
- An earlier assumption was an imbalance between the ability of the mucous membrane to defend itself and aggressive factors in the form of gastric acid and pepsin, which enter the intestine when the function of the obturator muscle of the gastric outlet is insufficient. It was also believed that the intestine was scratched by rough food. Today, these assumptions have been supplemented by the fact that a decrease in protective prostaglandins has been found in the mucous membrane of patients with peptic ulcer disease.
- A relationship has been found between the incidence of ulcers and blood type. Carriers of the first group with a Rh-positive factor are at greater risk.
- Soviet physiology was of the opinion that ulcers develop in people with excessive irritation of the cerebral cortex against the background of chronic stress or nervous experiences, when the release of gastric juice and inflammatory mediators (gastrin) is stimulated through the autonomic nervous system.
- Another interesting conclusion is associated with gastrin: prolonged exposure to the sun stimulates the release of this hormone and, accordingly, provokes an exacerbation of peptic ulcer disease or worsens its course.
- Taking medications such as corticosteroids and non-steroidal anti-inflammatory drugs can provoke ulcerations of the intestinal mucosa.
- Alcohol and nicotine worsen the condition of the mucous membrane, change the nature of the secretion of hydrochloric acid and pepsin by the stomach, affect the level of gastrin and somatostatin, and also reduce the protective properties of the mucus. Alcohol directly damages mucosal cells.
What are the symptoms of a duodenal ulcer?
The symptoms of stomach and duodenal ulcers are very close to each other. These are: pain, heartburn, nausea, vomiting, appetite disorders.
With ulcers, the duodenum is called late. They occur an hour and a half after eating. Hunger pains that occur if food has not been received for more than 4 hours are also characteristic. A type of such pain is night or early morning, similar to very acute hunger and sucking in the right hypochondrium. The nature of pain may vary from patient to patient. There are stabbing, aching, cutting, sucking or spasmodic pains of varying intensity and duration. In this case, the pain is located in the right half of the epigastric region (bulb ulcer). They can radiate to the right hypochondrium or to the back. With an ulcer located at the end of the intestine, the pain shifts more to the midline of the epigastrium or to its left half. The basis of the pain is a violation of the integrity of the intestinal wall, inflammation and accumulation of under-oxidized metabolic products.
- Heartburn
accompanies about a third of duodenal ulcers. It is due to the fact that the acidic contents of the stomach are thrown into the esophagus against the background of impaired motor activity of the stomach and intestines and inflammatory changes in the mucous membrane.
- Nausea and vomiting
eaten food or gastric contents are characteristic of high duodenal ulcers. With the development of secondary inflammation of the pancreas or gallbladder against the background of a peptic ulcer, vomiting of bile may occur.
- Appetite disorders
can manifest itself as an increase (sucking in the stomach is somewhat smoothed out by food intake) or an aversion to food and fear of it, since in the presence of an ulcer, food can provoke pain.
Complications of peptic ulcer
If the ulcer is not detected and treated in a timely manner, it may heal on its own. However, there is a high risk of developing a number of complications, which not only aggravate the course of the disease, but complicate treatment and worsen the prognosis for the patient. All complications are divided into:
Destructive - destroying the intestines:
- it's bleeding
- perforation - perforation
- penetration - penetration into a neighboring organ
Dysmorphic complications that change its structure:
- malignancy - the development of a malignant tumor at the site of the ulcer
- cicatricial deformation - a change in the structure of the walls and narrowing of the intestinal lumen until it is completely closed due to scars from ulcers.
Ulcers located on the anterior wall of the intestine are more likely to perforate. Ulcers of the posterior wall often penetrate the head of the pancreas.
Bleeding from the duodenum
Physical work and heavy lifting can provoke bleeding. But most often the cause is alcohol intake, if treatment with medications is not carried out or is inadequate. Therefore, up to 80% of this complication occurs in men. In this case, blood loss can be of different volumes.
When bleeding occurs, tar-colored stools or vomit with a color similar to coffee grounds appear. Minor bleeding may only result in diarrhea or pasty, dark stools. At the same time, with heavy blood loss, rapidly increasing weakness, dizziness, and even vomiting will be added. Bleeding is an emergency that requires calling an ambulance or going to a hospital emergency room on your own.
Symptoms of a perforated duodenal ulcer
Perforation of an ulcer means not only bleeding, but also the entry into the abdominal cavity of the contents of the duodenum, where pancreatic enzymes and bile are released. These are quite aggressive substances that quickly cause irritation of the peritoneum and lead to inflammation of the abdominal cavity (peritonitis).
If acute stabbing pain in the abdomen occurs against the background of a peptic ulcer, you should immediately call an ambulance. This pain appears more often in the right half of the epigastric region and can radiate to the right shoulder or scapula. The pain is so severe that the patient takes a forced position, lying on his side or back with his legs brought to his stomach. At the same time, the skin becomes very pale. The abdominal muscles tense, the person avoids any movement.
The most dangerous period is the period of imaginary well-being, which develops a few hours after the onset of perforation. Here the pain subsides somewhat, the patient begins to move and assures that he is feeling better. During this period, patients often recklessly refuse surgery that could save their life. But, if 6-12 hours pass from the onset of perforation, and the patient does not undergo surgery, his condition will sharply worsen:
- vomiting appears
- temperature increase
- the pain will return
- bloating will appear
- pulse and heartbeat increase
- peritonitis will develop, which will need to be operated on, and the prognosis for which at this stage is already worse.
Cicatricial stenosis of the duodenum
If exacerbations of duodenal ulcer follow one after another or the ulcerative defects are very large and deep, scars from ulcers can significantly deform or narrow the intestinal lumen. In this case, problems arise with the passage of food, and a narrowing (stenosis) of the intestine develops, which requires surgical treatment. Clinically, decompensated stenosis is manifested by vomiting, impaired passage of food and distension of the stomach. At the same time, disturbances in the content of salts and water in the body develop, which lead to lethargy, weakness, drowsiness, increased muscle tone, and a feeling of goosebumps running on the skin of the arms and legs.
Diagnostics
Today, the main and most informative method for identifying peptic ulcers is FGDS (fibrogastrodudenoscopy), in which, by inserting an endoscope (optical probe) into the stomach and duodenum, you can see the ulcer, assess its size and depth, and take the mucous membrane for examination (biopsy). or conduct a rapid urease test for the presence of Helicobacter pylori.
X-ray diagnostics, which is indispensable in clarifying complications, is of auxiliary importance.
Patients are also prescribed a clinical blood test, blood biochemistry, and a stool test for the Gregersen reaction (detection of occult blood).
Treatment of duodenal ulcers
With timely detection of duodenal ulcer in the acute stage, treatment is reduced to the prescription of conservative therapy (prescription of tablets, less often injections or drips). The times when surgical treatment methods were used for uncomplicated peptic ulcers are a thing of the past. If the peptic ulcer is complicated, then hospitalization in a surgical hospital is mandatory, and refusal to do so can be fatal. This does not mean that any bleeding will be operated on, but timely observation is indicated for every complicated duodenal ulcer.
Previously, it was customary to carry out seasonal (spring and autumn) preventive treatment of duodenal ulcer. Currently, this practice is not supported, as it has not brought the expected results. Treatment is prescribed for the period of exacerbation of duodenal ulcer.
Diet for ulcers
In case of duodenal ulcer, a 4g diet is prescribed for the period of exacerbation, which involves mechanical, chemical and temperature sparing. It is recommended to eat 5-6 meals a day in small portions. Food should be heated to a temperature of 36-37 degrees. Hot, cold and dry food are excluded (see). Alcohol and smoking on an empty stomach are prohibited.
- Preference is given to boiled, pureed food. Slimy porridges, non-rich creamy soups, mashed potatoes, pasta, rice and buckwheat are desirable. Steamed fish, poultry, boiled meat in the form of soufflé or minced meat and cutlets. Watermelons and bananas are allowed as fruits.
- You will have to give up fried, spicy, rich meat and bone broths, marinades, soda, strong tea, coffee, and yeast baked goods. The greatest harm is caused by fruits and vegetables containing fiber. You will have to forget about tomatoes, cucumbers, apples, pears, cabbage, carrots, radishes and other garden delights until the ulcerative defect heals.
- It is strictly forbidden to chew gum, which stimulates gastric secretion.
- Milk in this situation becomes an ambiguous product. In some patients, whole milk can irritate the ulcer due to calcium ions, while others drink it with pleasure, as it significantly reduces heartburn.
Drug treatment of duodenal ulcers
Peptic ulcer of the duodenum is currently treated with the following groups of drugs.
Medicines that reduce the production of gastric juice
The leading positions in this group are held by proton pump blockers, which slow down the secretion of hydrochloric acid:
- Funds on base- omez, gastrozole, bioprazole, demeprazole, lomac, zerocid, krismel, zolser, omegast, lossek, omezol, omitox, omepar, zhelkizol, peptikum, omipix, promez, peptikum, ricek, orthanol, romsec, sopral, ultop, helicid, cisagast , helol.
- Medicines based on pantoprazole- Controloc, Sanpraz, Nolpaza, Peptazol.
- Lansoprazole preparations- helicol, lanzap, lansofed, lanzotope, epicure, lancid.
- Based on rabeprazole- Zulbex, Zolispan, Pariet, Ontime, Khairabezol, Rabeloc.
- Esomeprazole - Nexium.
H2-histamine receptor blockers have practically ceased to be used to treat peptic ulcers, as they cause withdrawal syndrome (with abrupt cessation of use, the symptoms of the disease return).
- These are ranitidine (Gistac, Rannisan), famotidine (quamatel, ulfamid, gastrsidine), cimetidine (Belomet).
Selective blockers of M-cholinergic receptors (gastrocepin, pirencipin) reduce the production of pepsin and hydrochloric acid. Used as auxiliary medications for severe pain. May cause palpitations and.
Agents that increase the protective properties of the mucous membrane
- Sucralfate (Venter) forms a protective coating at the bottom of the ulcer.
- Sodium carbenoxolone (Ventroxol, Biogastron, Kaved-s) accelerates the restoration of the epithelium of the mucous membrane.
- Colloidal bismuth subcitrate () forms a film on the ulcer.
- Synthetic prostaglandins (enprostil) stimulate mucus production and cell restoration.
Other drugs
- Medicines that calm the central nervous system. Tranquilizers (seduxen, elenium, tazepam), (amitriptyline), sedatives (tenoten, valerian preparations, see).
- Blockers of central dopamine receptors (metoclopramide, raglan, cerucal) normalize intestinal motor activity.
The course of treatment for ulcers can take from two to six weeks, depending on the size of the defect and the general condition of the body.
It should be noted that a competent doctor who can monitor the treatment process and evaluate its results should prescribe treatment for duodenal ulcers, select medications and dosage regimens.
Treatment of duodenal ulcers with antibiotics
Antibiotic therapy for peptic ulcers has appeared since the undoubted participation of Helicobacter pylori microorganisms in the development of the disease was proven. In the early stages of the use of antibiotics, it was believed that the war should be waged until a victorious end, that is, the complete disappearance of the microbe, which was confirmed by culture, a urease test during FGDS, or a blood test for antibodies to the bacterium. Later it turned out that not all types of Helicobacter cause disease, that it is unrealistic to destroy all Helicobacter, since when it dies in the stomach and duodenum, it moves to the lower intestines, causing severe dysbiosis and inflammation.
Re-infection is also possible when using someone else's or shared utensils and the same FGDS, which therefore must be performed only according to strict indications.
However, today it is advisable to carry out one or two courses of therapy with antibacterial drugs (amoxicillin, clarithromycin or tetracycline) for proven Helicobacter infection. If after one course of antibiotics the bacteria are not killed, then this drug is not worth repeating. A different treatment regimen is selected.
Ulcer treatment regimen
First line Helicobacter pylori eradication scheme:
- Double dose proton pump inhibitor twice daily (eg 40 mg omeprazole or esomeprazole twice).
- Clarithromycin 500 mg twice daily or Josamycin 1000 mg twice daily.
- Amoxicillin 1000 mg 2 times a day.
- De-nol 240 mg twice a day.
Scheme of the second row (in the absence of FGD dynamics of ulcer size)
- Proton pump inhibitor in double dose 2 times a day (same as scheme 1)
- De-nol 240 mg twice a day.
- Metronidazole 500 mg three times a day.
- Tetracycline 500 mg 4 times a day.
Before starting therapy, Helicobacter pylori is detected using an immunological blood test (antibodies to the pathogen). Control – detection of Helicobacter antigens in feces. The urease breath test is not very informative.
The duration of eradication therapy is from 10 to 14 days. If treatment is ineffective with sequential regimens 1 and 2, Helicobacter pylori is typed and its sensitivity to drugs is determined.
Today, regimens with levofloxacin can only be used in regions of the Russian Federation where Helicobacter remains sensitive to this drug.
If duodenal ulcer is not associated with Helicobacter pylori infection, then treatment is carried out with medications that reduce the production of gastric juice. After 7-14 days of combination therapy, treatment is prescribed for another five weeks.
Alternative treatment for duodenal ulcers
Complete or partial distrust of traditional medicine most likely does not bode well for an ulcer sufferer. There are drugs for the treatment of ulcers, the effect of which has been proven in serious random studies in humans. Also, the effect of drugs is checked by everyday medical practice. Schemes are being refined and side effects of drugs are being identified. At the same time, no one canceled the alternative possibility of being treated with folk remedies.
One of the most effective traditional medicine for stomach and duodenal ulcers is considered freshly squeezed potato juice. It tastes rather unpleasant, but you can get used to it quite easily. It is better to use the Morning Rose or American varieties, but any unspoiled potato tuber will do. Preparing juice is quite labor-intensive, given that you only need to drink it fresh and 3 times a day, but you can get the hang of it if you want. The raw potato tuber is peeled, grated and squeezed through several layers of gauze. The juice should be drunk immediately, otherwise it turns black and loses its medicinal properties. The first 3 days only take a tablespoon before meals 30 minutes, preferably 3 times a day, then 3 days 2 tablespoons, gradually increasing to half a glass per dose and so on for 21-28 days. This requires adherence to a diet. After 2-3 weeks the course can be repeated. This really helps!
You can resort to traditional medicine, use or (1 dessert spoon on an empty stomach for 3 months), honey, propolis, herbs (plantain,), after going on a duodenal-friendly diet and taking 20 mg of omeprazole twice a day.